AIM 1

User-Centered Design Approach

For designing healthcare systems, such as electronic medical record systems, Kushniruk & Patel (2004) suggest using several stages with iterative cycles that return to prior stages for further design, development and evaluation. The planning stages of this approach include understanding the users, the environment, the tasks, functions of the interface, and optimal display of information (Johnson et al. 2005; Stone et al. 2005). Prototype evaluation can include heuristic testing, individual user testing, pluralistic or cognitive walkthroughs, usability inspections, and others, with data collection methods including observation, interviews, think-aloud protocols, surveys, and video analysis (Lee 1999; Taylor et al. 2011). Thus, our project employs a User-Centered Design approach with the following steps:

STEP 1: Planning. Collect information about users, site needs, consent requirements, and support needs of the target population. 

STEP 2: Develop Prototype. Apply principles of cognitive load to "chunk" the consent documents into one to two concepts per slide. Chunking text helps reduce the amount of information presented at once and thus facilitates learning (Clark & Mayer 2008; Mayer 2009). Add graphics to slides where a concept can be depicted visually. Include interactive questions with salient feedback to reinforce or clarify concepts.

STEP 3. Heuristic Evaluation. Biobank staff (e.g. site investigators, biobank directors, research coordinators) and external project consultants evaluate the prototypes developed in Step 2 by completing an e-survey based on formative evaluation recommendations for multimedia  (e.g., Alessi & Trollip 2001).

STEP 4: Revise Prototype. Revise prototype based on feedback from heuristic evaluation. Revisions to the prototype will be made for feedback categorized as critical and, if possible, important. Revisions based on desirable status wil be made if resources are available and the modification fits the initial design analysis. 

STEP 5: Focus Group Evaluation. Conduct focus groups at each site (Emory, Montefiore, and Northwestern) to learn from prospective users what they like and dislike about the prototype, and what they suggest as possible improvements. The focus groups are aimed at understanding how the prototype compares to the paper document for effectiveness at promoting understanding, the appropriateness and utility of the graphics, and the clarity and effectiveness of the interactive questions.

STEP 6: Revise Prototype. Revise prototype based on feedback from the focus groups. Revisions to the prototype will be made for feedback categorized as critical and, if possible, important. Revisions based on desirable status wil be made if resources are available and the modification fits the initial design analysis. 

STEP 7: Usability Interviews. Conducted with 3-5 individuals from the target user population at each site (Emory, Montefiore, and Northwestern). Individuals are asked to go through the prototype for their site using a think-aloud protocol, while being video-recorded and observed by a project research assistant who wil be trained as a usability tester. The observer looks for potential miscommunications; errors using the interface; strengths and weaknesses in the graphics, interactive questions, and the interface controls; and indications of satisfaction or dissatisfaction in the user. Once the user has completed the prototype, the observer conducts a brief interview with the user to explore issues and answer any questions.

STEP 8: Revise Final Prototype. Revise prototype based on feedback from the usability interviews to create the final version for each site. Revisions to the prototype will be made for feedback categorized as critical and, if possible, important. Revisions based on desirable status wil be made if resources are available and the modification fits the initial design analysis. 

STEP 9: Implementation. Implementation of the final prototype in a randomized controlled trial (Aim2).